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Date Archives: 5-Sep-2013

Question: Why don't Base Hospital Doctors at either Hospital carry a cellphone so when paramedic's call for a physician patch that call goes directly to them instead of being routed to triage and then to the red phone at either hospital? I have had a couple of calls recently where by the time I was speaking to the Doctor we were almost at the hospital when I got the order. I think this would be a tremendous asset for the medics if we could have this option.

Answer: Great question. The SWORBHP has explored many alternative models to the current system. We are aware of the challenges with the current system and are looking at ways we can improve.

Unfortunately, most cell phones do not work within the Emergency Departments at the various patch sites. Another challenge is that routing calls through CACC so that the patches can be recorded for quality assurance and investigation is also problematic when calls are sent directly to cell phones. The current strategy also allows multiple physicians to answer the call if one is unavailable (for instance attending to resuscitation).

Other Base Hospital Programs have remote on call physicians who answer paramedic patches when not on duty in the ED. The SWORBHP has considered moving to such as system however it is very costly given the number of patches. A further difficulty with this remote physician model is that paramedics must then patch again to the receiving facility once contact with the BHP has been made to notify the ED of their arrival. Unfortunately with the remote physician model, none of the information is passed to the receiving ED, giving them time to clear a bed in the trauma bay or cardiac room, and increase their situational awareness. This is quite a challenge for paramedics managing dynamic patients and attempting to make multiple phone calls with a relatively short transport time, and repeating relayed information.

We have reinforced (and will continue to do so) the importance of the BHP in responding as soon as possible to requests for patches from paramedics in the field. If you have a case where you have had an extensive delay, please let us know and we can investigate.

Question: There have been a few discussions flying around about a call where the patient had an internal defib whose activity was captured shocking the patient X 3 by the EMS defib. Of course, the whole discussion is treat vs. transport and shock once vs. follow the entire protocol. Can you provide some insight into these rare cases?

Answer: Great question. Occasionally paramedics may be in contact with a patient with an Implantable Cardioverter Defibrillator (ICD) who is conscious and alert however the ICD has discharged or continues to do so. In such cases, rapid transport is the key as long as the patient remains stable and/or has a return of spontaneous circulation following the shocks.

If a patient with an ICD presents in cardiac arrest and the rhythm is ventricular fibrillation (VF), then clearly the ICD is not functioning properly in failing to concert the VF into a perfusing rhythm.

Paramedics when confronted with a patient with an ICD who is in full cardiac arrest should follow their Medical Cardiac Arrest Medical Directive.

The Advanced Life Support Patient Care Standards (the medical directives) apply to patients with an ICD in the same way as patients who do not have an ICD.